A) In what possible sense is the Affordable Care Act "socialized medicine"?

B) We not only already have MUCH worse rationing by the insurance cartel than anything imaginable in Canada or Europe, and have had for years, but without the ACA it's been getting steadily worse and worse.

...and davey, you don't think rationing occurs already in the US? The US pays twice as much per capita for health care with worse outcomes in general and 50 million uninsured..not to mention we have to reduce the cost of medical care for long term economic viability. Physician compensation is likely the last on the table as far as needed reform in the US. Sounds like just rwing naysayer nonsense and head buried in the sand to neglect that medical care has to change. It's a complex subject just on physician compensation let alone Medicare liability down the road and how it should be modified.

In response to Uwe Reinhardt’s recent post on “rationing” doctors’ salaries, a number of readers wrote in asking about physician compensation in other countries.

Doing a direct comparison of remuneration across different countries is tricky because the same salary may allow for different standards of living in different places.

One way to compare cross-country data is to adjust the salaries for purchasing-power parity — that is, adjusting the numbers so that $1,000 of salary buys the same amount of goods and services in every country, providing a general sense of a physician’s standard of living in each nation.

These numbers are in the second, fourth and sixth columns of the chart below.

They show that American general practitioners and nurses earn more than their counterparts in other developed countries, and American specialists are close to the top of the pack.

Source: Congressional Research Service (CRS) analysis of Remuneration of Health Professions, OECD Health Data 2006 (October 2006), available at [http://www.ecosante.fr/OCDEENG/70.html].Sorted by specialists’ compensation. Amounts are adjusted using U.S. dollar purchasing powerparities. Amounts from previous years are trended up to 2004 dollars using the annualized Bureau ofLabor Statistics Employment Cost Index for wages and salaries of health services workers in privateindustry. It is not known whether wage growth in health professions in other countries was similar tothat in the United States. Amounts are from previous years for 10 countries: data for Australia,Canada, Denmark (for specialists and nurses), Finland (for nurses), and the Netherlands are from2003; data for Belgium (for specialists), Denmark (for general practitioners), New Zealand (fornurses), and Sweden are from 2002; data for Switzerland and the United States (for specialists andgeneral practitioners) are from 2001; and data for Belgium (for general practitioners) and the UnitedStates (for nurses) are from 2000. Ratios of salaries to GDP per capita reflect the year the data wascollected and are not adjusted for inflation. For countries that have both self-employed and salariedprofessionals in a given field, the amount presented here is the higher of the two salaries. Fourcountries have both salaried and self-employed specialists: the Czech Republic (where compensationis $29,484 for salaried and $34,852 for self-employed specialists), Greece ($67,119 and $64,782), theNetherlands ($130,911 and $252,727), and the United States ($170,300 and $229,500). One countryhas both salaried and self-employed general practitioners: in the United States, salaried generalpractitioners earn $134,600, compared with $154,200 if self-employed. All nurses are salaried amongthis data.

Another way is look at how a doctor’s salary compares to the average national income in that doctor’s country — that is, gross domestic product per capita. These numbers are in the third column, fifth and seventh columns of the chart.

As a country’s wealth rises, so should doctors’ pay. But even accounting for this trend, the United States paysdoctors more than its wealth would predict:

According to this model, the 2007 report says, “The U.S. position above the trendline indicates that specialists are paid approximately $50,000 more than would be predicted by the high U.S. GDP. General practitioners are paid roughly $30,000 more than the U.S. GDP would predict, and nurses are paid $8,000 more.”

But it’s important to keep in mind, the report notes, that health care professionals in other O.E.C.D. countries pay much less (if anything) for their medical educations than do their American counterparts. In other words, doctors and nurses in the rest of the industrialized world start their medical careers with much less student loan debt compared to medical graduates in the United States.

For more data on health spending in O.E.C.D. countries, go here. For a recent American-only survey on the pay of physicians with various specialties, go here."

I'd also like to know what the alternative is. Do we just condemn tens of millions of American children, women and men to painful, unnecessary early deaths because insurance is unavailable and/or unaffordable, and they don't have the hundreds, thousands, tens of thousands of dollars or more to pay out of pocket when they get sick or injured?

Do conservatives REALLY want to transform the United States into THAT?

The ACA is admittedly a sorry substitute for single payer. But it's infinitely better than nothing.

davie, no wonder you always look like a braindead moron that gets his sorry ass kicked everytime he opens his mouth. It is apparent you don't know shit about anything but right wing propaganda. Why don't you try to learn something for a change?

It is a lie that outcomes are worse in the US. They are far better. One of the reasons we pay so much for our healthcare is that it is of such high quality. The other reason is that Medicare is biffing the medical industry up. Medicare needs to be abolished.

"The Conference Board, which has been issuing the report card since 1996, ranked the 16 countries according to 11 criteria, including life expectancy, mortality due to cancer, circulatory diseases, respiratory diseases, metal disorders, as well as infant mortality and self-reported health status.

"Japan was once again the top-ranking country. Switzerland, Italy, and Norway also earned "A" grades.

"B" grades were given to Sweden, France, Finland, Germany, Australia and Canada, while Netherlands, Austria and Ireland earned a "C" grade, the report showed.

Along with the United States, Denmark and the United Kingdom got "D" grades.

Canada and the United States both earned "A" grades on self-reported health status, ranking first and second, respectively, among the 16 countries.

Canada ranked higher than the United States on all of the mortality measures except for mortality due to cancer, a criteria for which both countries earned a "B" grade.

The Conference Board said top-performing countries achieved better health outcomes on broad actions such as environmental stewardship and health promotion programs that focus on changes in lifestyle, along with education, early childhood development, and income to improve health outcomes.

You have to be careful with statistics. Many of them will lead you astray. Life expectancy and deaths from cancer for example have little to do with healthcare. They have more to do with a host of environmental factors. The five year survival rate from cancer is much higher here than elsewhere.

<<It is a lie that outcomes are worse in the US. They are far better. One of the reasons we pay so much for our healthcare is that it is of such high quality.>>

We have excellent medical care in this country for the fewer and fewer Americans who have access to it. It's just that we have such a lousy health care delivery system. The ACA makes it much more available, but it still relies on a very inefficient, profit-driven private cartel to deliver a service literally everyone needs. Since it only exists to deny needed care and skim a percentage off of the top, we really need to get private insurance out of health care, and do the only sane thing: universal Medicare.

<<The other reason is that Medicare is biffing the medical industry up. Medicare needs to be abolished.>>

Beyond the obvious fact that most seniors would have no health care without Medicare, since administrative costs in non-profit Medicare are only about 2 percent of operating expenditures, while they're 17% (PLUS profit) in the private insurance industry, that doesn't sound very smart.

The whole Paul Ryan/Mitt Romney/GOP proposal to kill... excuse me, to "reform" Medicare is predicated on the idea that the elderly -- people who BY DEFINITION have the most medical problems -- will have no problem buying all the insurance they need for very little. And that despite the fact that even young healthy people increasingly can't find affordable insurance (and often find that what they have, if anything, is worthless or even canceled just when they need it the most).

IN those days people paid cash for medical care. They didn't have insurance for basic care. Many had insurance for catastrophic care, and if they didn't they were taken care of by extended family and charity. That is the way it should be. The current system of Medicare is completely riddled with fraud and is bankrupt. If we continue down this path, no one will have medical care, period.

<<IN those days people paid cash for medical care. They didn't have insurance for basic care.>>

You obviously have no idea what the medical needs of the elderly are. Or what the resources of most Americans have ever been.

<<and if they didn't they were taken care of by extended family and charity.>>

In storybooks, perhaps. But in the real world, most extended families haven't had those resources, even if they existed and were willing, and "charity" has NEVER done more than provide some help for a tiny percentage of poor -- NOT middle class -- people. For those who thought they might have a modest home and pension to retire on, the medical needs of growing old meant ruin.~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

breadstick, you think most seniors can afford a $100K in cash for a heart attack? ....you're fucking dreaming.

"Mr. Antos and Mr. Hacker, each in his way, are describing how normal market forces mostly break down in the American health care system.

One reason, as mentioned previously, is that people like to live and be healthy. There seems to be no upward limit on the amount of money that most people would spend toward that goal (as evident in the number of medical-related bankruptcies in America). And that, of course, puts the purveyors of health care at a distinct advantage over the consumers of health care.

My colleague David Leonhardt, who writes the Economic Scene column, notes wisely that people in other countries enjoy living just as much as Americans do, and yet some of those countries spend less on health care and get better results. It is a good reminder that many complicated factors contribute to the high cost of health care, and love of life explains only so much.

Another reason normal market forces fail in the health care system is a lack of clear information. Purchasing health care is not like buying a car — a product that consumers, based on a lifetime of experience, know and understand.

Comparing two automobiles, and the sticker prices on the windows, is a whole lot easier than comparing two heart surgeries or cancer treatments – especially for someone who has never purchased a surgery or treatment before. Not to mention that for folks with insurance, the price tag is rarely even discussed. Or that people often do not have control over medical expenses, the way they can control expenses when buying a car.

And in health care, the product for sale is constantly changing. A day in the hospital in 2010 is nothing like a day in the hospital was in 2005 or 1995.

The health care sector, it seems, is constantly faced with a problem similar to the one that confronted big banks during the financial meltdown as they struggled to set valuations, or prices, on mortgage-backed securities. With no clear ability to set rational prices, trading froze. With a similar absence of rational price-setting, consumers of health care just keep buying and buying and buying, generally on the good advice of their doctors.

The main arguments are well known. The fee-for-service model that prevails throughout the system encourages more care not more effective care. Paying to treat the millions of uninsured, increases expenses for everyone. Too many people do not eat right and excercise. Medicaid and Medicare pay providers too little. Private insurers pay providers too much. There is waste and fraud. There is not enough competition or choice."

Why should "middle class" people need help at all? You pay for your mortgage over thirty years, don't you? Why should a catastrophic medical bill be any differen?

The bottom line is that people are happiest and healthiest when they are self sufficient. You would have everyone be dependent upon government.

On Tuesday, May 15, 2012 11:28:29 PM UTC-7, Lobo wrote:

<<IN those days people paid cash for medical care. They didn't have insurance for basic care.>>

You obviously have no idea what the medical needs of the elderly are. Or what the resources of most Americans have ever been.

<<and if they didn't they were taken care of by extended family and charity.>>

In storybooks, perhaps. But in the real world, most extended families haven't had those resources, even if they existed and were willing, and "charity" has NEVER done more than provide some help for a tiny percentage of poor -- NOT middle class -- people. For those who thought they might have a modest home and pension to retire on, the medical needs of growing old meant ruin.~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

On Wednesday, May 16, 2012 2:02:30 AM UTC-4, bagel wrote:

IN those days people paid cash for medical care. They didn't have insurance for basic care. Many had insurance for catastrophic care, and if they didn't they were taken care of by extended family and charity. That is the way it should be. The current system of Medicare is completely riddled with fraud and is bankrupt. If we continue down this path, no one will have medical care, period.

On Tuesday, May 15, 2012 10:06:34 PM UTC-7, Lobo wrote:

<<That is untrue. They had healthcare.>>

Millions didn't. And those who did but who weren't wealthy faced ruin if they availed themselves of it.

Oh yeah, 200 million Americans are ecstatic when republofacists let the wall street babies do anything they want, crash the economy, and walk away with their pockets stuffed with trillions in cash while 80% of Americans go backwards for 30 years....how fucking clueless can you get breadstick? You are supporting institutionalized bribery and theft unlike the world has ever seen. Fuck that and fuck you.

<<breadstick, you think most seniors can afford a $100K in cash for a heart attack? ....you're fucking dreaming.>>

LOL! I can at least understand why Mitt Romney, who was born with a platinum spoon up his ass, has zero empathy with and understanding of how real Americans live. But Bagel doesn't strike me as the born-to-zillionaires type.